Displaying 58401-58410 of 1611142 results.
ID:
58401
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
2054269
NDC:
Tier Level:
5
Qty Limit?:
1
Qty Limit Amt:
0
Qty Limit Days:
0
ID:
58402
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
432400
NDC:
Tier Level:
5
Qty Limit?:
0
Qty Limit Amt:
120
Qty Limit Days:
30
ID:
58403
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1940654
NDC:
Tier Level:
5
Qty Limit?:
0
Qty Limit Amt:
180
Qty Limit Days:
30
ID:
58404
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1944382
NDC:
Tier Level:
5
Qty Limit?:
0
Qty Limit Amt:
30
Qty Limit Days:
30
ID:
58405
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1944376
NDC:
Tier Level:
5
Qty Limit?:
0
Qty Limit Amt:
60
Qty Limit Days:
30
ID:
58406
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1921081
NDC:
Tier Level:
3
Qty Limit?:
0
Qty Limit Amt:
1
Qty Limit Days:
30
ID:
58407
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1866047
NDC:
Tier Level:
2
Qty Limit?:
1
Qty Limit Amt:
0
Qty Limit Days:
0
ID:
58408
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1099026
NDC:
Tier Level:
2
Qty Limit?:
1
Qty Limit Amt:
0
Qty Limit Days:
0
ID:
58409
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1099269
NDC:
Tier Level:
2
Qty Limit?:
1
Qty Limit Amt:
0
Qty Limit Days:
0
ID:
58410
Formulary ID:
00021020
Formulary Version:
14
Contract Year:
2021
RXCUI:
1006065
NDC:
Tier Level:
2
Qty Limit?:
1
Qty Limit Amt:
0
Qty Limit Days:
0
58401584025840358404584055840658407584085840958410